Category: Nevin Manimala

West J Emerg Med. 2024 Nov;25(6):883-889. doi: 10.5811/westjem.18468.

ABSTRACT

INTRODUCTION: Coronavirus 2019 (COVID-19) has had a devastating impact on mental health and access to addiction treatment in the United States, including in California, which resulted in the highest rates of emergency department visits (ED) for opioid poisoning in 2020. As California slowly returns to pre-pandemic normalcy, it remains uncertain whether the rates of opioid-related events have slowed down over time. We hypothesized that the number of opioid-related ED visits were exacerbated after the period of the COVID-19 pandemic and continue at a high rate in the present.

METHODS: In this analysis we searched the University of California (UC) Health Data Warehouse-a database of electronic health records from six academic medical centers-for opioid related ED visits, identifiying using the following International Classification of Diseases, 10^th Ed, Clinical Modification codes: F11 codes, and T40.0*, T40.1*, T40.2*, T40.3*, T40.4*, T40.6*. Opioid overdose-associated visits were classified by types of opioids involved: heroin (T40.1*); prescription opioids (T40.2* or T40.3*); and synthetic opioids (T40.4*). We performed interrupted time analysis to estimate the immediate (level) change and change-in-time trend (trend change), from before (January 2018-October 2019) and during the pandemic (April 2020-December 2022). Monthly visit rates were evaluated with negative binomial regression adjusted for first-order autoregression and using all-cause ED counts as the offset. We present effect sizes as rate ratios (RR) and 95% confidence intervals (CI), tested at α = .05.

RESULTS: We observed a decrease in overall ED visits from 28,426 to 25,121 visits in December 2019 and June 2021, respectively across all six UC Health Centers. Before COVID-19, we found that ED visit rates steadily increased for all outcomes (P < 0.05) except synthetic opioids. Total opioid-related ED visit rates increased by 15% (RR 1.15, 95% CI 1.02-1.29, P = 0.20) immediately after March 2020 before decreasing by 0.5% every month, albeit without statistical significance (RR .995, 95% CI .991-1.00, P = 0.06). Opioid-related events across the six academic medical centers increase from 232 in December 2019, representing a single month’s total, and peaked at 315 in June 2021. Similar trends were observed with prescription opioid overdoses, with a step increase of 44% (RR 1.44, 95% CI 1.10-1.89, P = .008) before plateauing after March 2020 (RR 1.01, 95% CI .998-1.02, P = 0.12). Specifically, the total number of prescription opioid-related ED visits more than doubled between December 2019 (22 visits) and June 2021 (49 visits). After March 2020, ED visit rates for synthetic opioid overdoses were increasing steadily by 4% every month (RR 1.04, 95% CI 1.02-1.06, P = .001), unlike with heroin, which was observed with an 8% monthly reduction (RR .92, 95% CI .90-.93, P < .001). No immediate increase in visit rates was observed for either opioid.

CONCLUSION: While opioid-related ED admissions among the UC health centers showed an overall decrease, prescription and synthetic opioid overdoses remained significantly higher than pre-pandemic trends as of December 2022. A multilevel approach to improve awareness of new opioid health policies could ameliorate these alarming rises in the post-pandemic era.

PMID:39625758 | DOI:10.5811/westjem.18468

West J Emerg Med. 2024 Nov;25(6):869-874. doi: 10.5811/westjem.18569.

ABSTRACT

INTRODUCTION: As fentanyl has become more readily available, opioid-related morbidity and mortality in the United States has increased dramatically. Preliminary studies suggest that high-affinity, partial mu-opioid receptor agonists such as the combination product buprenorphine-naloxone may reduce mortality from overdose and promote remission. With the escalating prevalence of opioid use disorder (OUD), it is essential to evaluate the effectiveness of opioid agonists like buprenorphine-naloxone. This study examines mortality and remission rates for OUD patients prescribed buprenorphine-naloxone to determine the efficacy of this treatment toward these outcomes.

METHODS: We carried out a retrospective analysis using the US Collaborative Network database in TriNetX, examining de-identified medical records from nearly 92 million patients across 56 healthcare organizations. The study spanned the years from January 1, 2017-May 13, 2022. Cohort 1 included OUD patients who began buprenorphine-naloxone treatment within one-year post-diagnosis, while Cohort 2, the control group, consisted of OUD patients who were not administered buprenorphine. The study measured mortality and remission rates within a year of the index event, incorporating propensity score matching for age, gender, and race/ethnicity.

RESULTS: Prior to propensity matching, we identified a total of 221,967 patients with OUD. Following exclusions, 61,656 patients treated with buprenorphine-naloxone showed 34% fewer deaths within one year of diagnosis compared to 159,061 patients who did not receive buprenorphine (2.6% vs 4.0%; relative risk [RR] 0.661; 95% confidence interval [CI] 0.627-0.698; P < 0.001). The remission rate was approximately 1.9 times higher in the buprenorphine-naloxone group compared to the control group (18.8% vs 10.1%; RR 1.862; 95% CI 1.812-1.914; P < 0.001). After propensity matching, the effect on mortality decreased but remained statistically significant (2.6% vs 3.0%; RR 0.868; 95% CI 0.813-0.927; P < 0.001) and the remission rate remained consistent (18.8% vs 10.4%; RR 1.812; 95% CI 1.750-1.876; P < 0.001). Number needed to treat for benefit was 249 for death and 12 for remission.

CONCLUSION: Buprenorphine-naloxone was associated with significantly reduced mortality and increased remission rates for patients with opioid use disorder and should be used as a primary treatment. The recognition and implementation of treatment options like buprenorphine-naloxone is vital in alleviating the impact of OUD.

PMID:39625756 | DOI:10.5811/westjem.18569

J Am Coll Health. 2024 Dec 3:1-12. doi: 10.1080/07448481.2024.2404945. Online ahead of print.

ABSTRACT

Objective: Examine associations between ultra-processed food (UPF) intake and diet quality (DQ) in college students. Participants: Analysis included 695 participants ages 18-39 years. Methods: Dietary data were collected using the online Diet History Questionnaires II and III. The Healthy Eating Index 2020 (HEI-2020) adult score assessed DQ. NOVA classification was used to identify UPFs. Multivariable linear regression was used to examine associations between %EI from UPF and HEI-2020 total and component scores, controlling for gender, race, smoking, campus meal plan, and EI. Results: Mean age was 19.2 years. In fully adjusted models a statistically significant inverse association was found between %EI from UPF and HEI-2020 total scores (F = 37.81, p < 0.001, R²=0.26), all HEI adequacy scores except whole grains (not significant) and dairy (weak positive association), and for saturated fat, refined grains, and sodium scores. Conclusions: Addressing UPF intake in young adult college students could be a potential strategy to improve DQ.

PMID:39625752 | DOI:10.1080/07448481.2024.2404945

JMIR Public Health Surveill. 2024 Dec 3;10:e59844. doi: 10.2196/59844.

ABSTRACT

BACKGROUND: Population-based databases are valuable for perinatal research. The California Department of Health Care Access and Information (HCAI) created a linked birth file covering the years 1991 through 2012. This file includes birth and fetal death certificate records linked to the hospital discharge records of the birthing person and infant. In 2019, the University of California Study of Outcomes in Mothers and Infants received approval to create similar linked birth files for births from 2011 onward, with 2 years of overlapping birth files to allow for linkage comparison.

OBJECTIVE: This paper aims to describe the University of California Study of Outcomes in Mothers and Infants linkage methodology, examine the linkage quality, and discuss the benefits and limitations of the approach.

METHODS: Live birth and fetal death certificates were linked to hospital discharge records for California infants between 2005 and 2020. The linkage algorithm includes variables such as birth hospital and date of birth, and linked record selection is made based on a “link score.” The complete file includes California Vital Statistics and HCAI hospital discharge records for the birthing person (1 y before delivery and 1 y after delivery) and infant (1 y after delivery). Linkage quality was assessed through a comparison of linked files and California Vital Statistics only. Comparisons were made to previous linked birth files created by the HCAI for 2011 and 2012.

RESULTS: Of the 8,040,000 live births, 7,427,738 (92.38%) California Vital Statistics live birth records were linked to HCAI records for birthing people, 7,680,597 (95.53%) birth records were linked to HCAI records for the infant, and 7,285,346 (90.61%) California Vital Statistics birth records were linked to HCAI records for both the birthing person and the infant. The linkage rates were 92.44% (976,526/1,056,358) for Asian and 86.27% (28,601/33,151) for Hawaiian or Pacific Islander birthing people. Of the 44,212 fetal deaths, 33,355 (75.44%) had HCAI records linked to the birthing person. When assessing variables in both California Vital Statistics and hospital records, the percentage was greatest when using both sources: the rates of gestational diabetes were 4.52% (329,128/7,285,345) in the California Vital Statistics records, 8.2% (597,534/7,285,345) in the HCAI records, and 9.34% (680,757/7,285,345) when using both data sources.

CONCLUSIONS: We demonstrate that the linkage strategy used for this data platform is similar in linkage rate and linkage quality to the previous linked birth files created by the HCAI. The linkage provides higher rates of crucial variables, such as diabetes, compared to birth certificate records alone, although selection bias from the linkage must be considered. This platform has been used independently to examine health outcomes, has been linked to environmental datasets and residential data, and has been used to obtain and examine maternal serum and newborn blood spots.

PMID:39625748 | DOI:10.2196/59844

Interact J Med Res. 2024 Dec 3;13:e53248. doi: 10.2196/53248.

ABSTRACT

BACKGROUND: Numerous studies have been conducted to predict depressive symptoms using passive smartphone data, mostly integrating the GPS signal as a measure of mobility. Environmental factors have been identified as correlated with depressive symptoms in specialized studies both before and during the pandemic.

OBJECTIVE: This study combined a data-based approach using passive smartphone data to predict self-reported depressive symptoms with a wide range of GPS-based environmental factors as predictors.

METHODS: The CORONA HEALTH app was developed for the purpose of data collection, and this app enabled the collection of both survey and passive data via smartphone. After obtaining informed consent, we gathered GPS signals at the time of study participation and evaluated depressive symptoms in 249 Android users with the Patient Health Questionnaire-9. The only GPS-based data collected were the participants’ location at the time of the questionnaire, which was used to assign participants to the nearest district for linking regional sociodemographic data. Data collection took place from July 2020 to February 2021, coinciding with the COVID-19 pandemic. Using GPS data, each dataset was linked to a wide variety of data on regional sociodemographic, geographic, and economic characteristics describing the respondent’s environment, which were derived from a publicly accessible database from official German statistical offices. Moreover, pandemic-specific predictors such as the current pandemic phase or the number of new regional infections were matched via GPS. For the prediction of individual depressive symptoms, we compared 3 models (ie, ridge, lasso, and elastic net regression) and evaluated the models using 10-fold cross-validation.

RESULTS: The final elastic net regression model showed the highest explained variance (R²=0.06) and reduced the dataset from 121 to 9 variables, the 3 main predictors being current COVID-19 infections in the respective district, the number of places in nursing homes, and the proportion of fathers receiving parental benefits. The number of places in nursing homes refers to the availability of care facilities for the elderly, which may indicate regional population characteristics that influence mental health. The proportion of fathers receiving parental benefits reflects family structure and work-life balance, which could impact stress and mental well-being during the pandemic.

CONCLUSIONS: Passive data describing the environment contributed to the prediction of individual depressive symptoms and revealed regional risk and protective factors that may be of interest without their inclusion in routine assessments being costly.

PMID:39625745 | DOI:10.2196/53248

Chaos. 2024 Dec 1;34(12):123118. doi: 10.1063/5.0223045.

ABSTRACT

The transient activity of the brain can be characterized by stable heteroclinic channels (SHCs) in the phase space of dynamical models, and the saddle points can represent the metastable states of brain activity. Inspired by this view, based on the hippocampal CA3-CA1 synaptic network model of memory we constructed earlier, we encode memory engrams as trajectories within the SHC in phase space. Short-term memory is transformed into long-term memory and then is encoded as trajectories within the SHC. The saddle points indicate the information blocks that have been segmented during the process of short-term memory. A stable heteroclinic network (SHN) is composed of multiple SHCs, whose trajectories express the memory engrams formed after the conversion of multiple short-term memories into long-term memories. From the existence conditions of SHC and SHN, the asymmetric regulation of neurotransmitters such as acetylcholine on the inhibition strength of adjacent postsynaptic neurons determines the capacity of short-term memory and participates in the encoding of long-term memory. Numerical results reveal the hysteresis effect of saddle points on the trajectories that reflect the limited capacity of short-term memory. All saddle points in the SHNs enable long-term memory to possess an extremely large capacity. Moreover, while noise in the hippocampal circuit can lead to the loss or confusion of memory information, it can also facilitate the encoding of long-term memories. The model and its theoretical analysis allow us to explain memory from the perspective of dynamics and have guiding significance for understanding the encoding and storage process of memory.

PMID:39625669 | DOI:10.1063/5.0223045

Eur J Nucl Med Mol Imaging. 2024 Dec 3. doi: 10.1007/s00259-024-07006-z. Online ahead of print.

ABSTRACT

PURPOSE: Aim of this study was to analyze the safety of prostate-specific membrane antigen radioligand therapy (PSMA-RLT) in patients with metastatic castration-resistant prostate cancer (mCRPC) with preexisting moderate to severe thrombocytopenia (CTCAE ≥ 2).

MATERIALS AND METHODS: Seventeen mCRPC patients with preexisting thrombocytopenia (platelet count < 75 × 10⁹/L) were included in this study. Patients received a median of 3 cycles of [¹⁷⁷Lu]Lu-PSMA-617 (range 1-6). The course of platelet cell count was closely monitored within and after the PSMA-RLT and analyzed statistically and according to CTCAE.

RESULTS: No significant difference in platelet counts was observed between baseline and follow-up after each PSMA-RLT cycle: first cycle (54.18 ± 16.07 at baseline vs. 59.65 ± 39.16 at follow up [in × 10⁹/L], p= 0.834), second cycle (58.56 ± 16.43 vs. 107.1 ± 56.44, p = 0.203), and third cycle (60.38 ± 16.57 vs. 132.1 ± 80.43, p = 0.148), respectively. Similarly, baseline and end of treatment values, irrespective of the number of administered cycles, did not reveal a significant difference (54.18 ± 16.07 vs. 72.06 ± 71.9, p = 0.741). After the end of therapy, irrespective of the number of administered cycles, 29.4% of patients remained stable in terms of CTCAE scoring, 41.2% changed to a higher score and 29.4% improved to a lower score. We observed no critical bleeding events due to thrombocytopenia.

CONCLUSION: Despite the common consideration of marked preexisting thrombocytopenia as a contraindication for RLT, this study indicates feasibility of PSMA-RLT in patients with preexisting thrombocytopenia of grade ≥ 2, as in our preliminary experience, there was no RLT-induced significant deterioration of platelet cell count. Thus, patients with thrombocytopenia should not be categorically excluded from receiving PSMA-RLT.

PMID:39625666 | DOI:10.1007/s00259-024-07006-z

Mol Genet Genomics. 2024 Dec 3;299(1):112. doi: 10.1007/s00438-024-02204-8.

ABSTRACT

Early seedling vigour (ESV) is a key trait that enhances early establishment, stress tolerance, and grain yield in rice, especially in direct-seeded rice (DSR) systems. The aus varietal groups is known for its high seedling vigour. The screening of aus diversity panel for ESV traits and subsequent genome-wide association study (GWAS) can lead to the identification of genetic components of ESV. Here, we report the genetic variation in seven ESV traits along with days to 50% flowering and grain yield in a panel of 181 aus accessions evaluated under field conditions. We observed significant variations in the studied traits. The vegetative vigour, scored visually, was significantly correlated with most of the traits, suggesting its impact on overall plant performance. Comparative analysis of aus genetic groups revealed significant variations, and the subpopulation that includes early maturing drought tolerant genotypes was the most vigorous, and thus ideal for donor selection. GWAS using 918, 863 single nucleotide polymorphism (SNP) markers identified 14 significant QTLs, including seven novel ones, linked to vegetative vigour, average growth rate and seedling biomass. Candidate genes like OsPDR1, NCKAP1, and OsSAUR10, involved in jasmonic acid biosynthesis, ABA signaling, and brassinosteroid pathways, were identified to be associated with ESV regulation. This study provides insights into the genetic basis of ESV in aus rice, identifying promising germplasm and genes that could improve seedling vigour and yield in DSR systems. Future research should validate these findings and integrate them into breeding programs for enhanced rice performance in various environments.

PMID:39625651 | DOI:10.1007/s00438-024-02204-8

J Psycholinguist Res. 2024 Dec 3;53(6):78. doi: 10.1007/s10936-024-10118-0.

ABSTRACT

Whether conscious awareness is critical for detecting semantic information in individual words remains debated. We hypothesize that this issue is specific to language type and that orthography serves as a mediator between semantics and conscious awareness. Using a priming-based paradigm called breaking continuous flash suppression (b-CFS) with a full factorial design, this study investigated whether orthographic similarity and semantic relatedness between the prime and target could modulate conscious access to Chinese single characters. Statistics indicated that semantic relatedness did not facilitate the character’s breakthrough from CFS unless combined with orthographic similarity, although orthographic similarity alone had an inhibitory effect. The results were discussed in light of the “unconscious binding” hypothesis and object-updating theory in visual perception as well as the unique sub-morphemic construction in psycholinguistics. Our findings demonstrate the possibility of orthography-based semantic processing occurring outside of conscious awareness and suggest that the multilevel interaction activation model may be applicable to the early recognition of Chinese characters.

PMID:39625648 | DOI:10.1007/s10936-024-10118-0

J Dev Behav Pediatr. 2024 Nov 26. doi: 10.1097/DBP.0000000000001329. Online ahead of print.

ABSTRACT

OBJECTIVE: Despite automatic eligibility, many children with medical conditions associated with increased risk of disability do not receive Early Intervention (EI) services. State EI programs have compiled lists of established conditions to facilitate automatic enrollment; yet little is known about professionals’ knowledge and utilization of these lists. This study examined the knowledge of these established conditions lists and associated policies and procedures among pediatricians and EI personnel. State initiatives and approaches undertaken to improve familiarity and utilization of the list, along with recommendations for its improvement were examined.

METHOD: In this mixed-methods study, self-rated survey data were collected from 193 EI personnel responsible for intake and eligibility evaluations, and 69 pediatricians providing primary care. Follow-up interviews were then conducted with 45 EI personnel and 22 pediatricians. Quantitative data were analyzed using descriptive statistics, and qualitative data underwent thematic analysis.

RESULTS: Pediatricians rated their knowledge of their state’s established conditions list and related policies and procedures lower than EI personnel. Both groups emphasized the significance of the list in referral and eligibility determination but highlighted its underutilization and lack of professional development activities. Consequently, recommendations were made to improve state established conditions lists and their utilization in ensuring direct EI enrollment for eligible children.

CONCLUSION: The lack of shared knowledge and utilization of established conditions lists and associated policies and procedures among pediatricians and EI personnel may result in referral failure for eligible children. Addressing this challenge requires improvement in the content and statewide distribution to improve accessibility and usability.

PMID:39625642 | DOI:10.1097/DBP.0000000000001329